Structure and Function
of the Kidney
(homework)
1. Describe the location and gross structure of the
kidney.
2. Explain why the kidney receives such a large
percentage of the cardiac output and describe the
mechanisms for regulating renal blood flow.
3. Describe the structure and function of the
glomerulus and tubular components of the nephron
in terms of regulating the composition of the
extracellular fluid compartment.
4. Explain the concept of tubular transport
mechanisms.
5. Describe how the kidney produces
concentrated or diluted urine.
6. Characterize the function of the
juxtaglomerular complex.
7. Relate the function of the kidney to drug
elimination.
8. Explain the endocrine functions of the
kidney.
9. Relate the sodium reabsorption function of the
kidney to action of diuretics.
10. Describe the characteristics of normal urine.
11. Explain the significance of casts in the urine.
12. Explain the value of urine specific gravity in
evaluating renal function.
13. Explain the concept of the glomerular filtration
rate.
14. Explain the value of serum creatinine levels in
evaluating renal function.
Fill in the blanks.
1. The……………….. are paired, bean-shaped
organs that lie outside the peritoneal cavity in
the back of the upper abdomen.
2. The _____________ is the place where blood
vessels and nerves enter and leave the kidney.
3. ……………………………………………..
…………………..are the functional units of the
kidney.
4. The…………………. contains the glomeruli and
convoluted tubules of the nephron and blood
vessels.
5. The medulla consists of the…………………….
that extend into the medulla.
6. Each kidney is supplied by a single renal
artery that arises on either side of
the………………………………….
7. The afferent arterioles that supply the………
………………. arise from the intralobular
arteries.
8. The ___________ is a unique, high-pressure
capillary filtration system.
9. ____________ are low-pressure vessels that are
adapted for reabsorption rather than filtration.
10. The _____________ passes through each of
these segments before reaching the pelvis of the
kidney.
11. The _____________ is regulated by the
constriction and relaxation of the afferent and
efferent arterioles.
12. Substances move from the tubular filtrate
into the tubular cell along a _______________
gradient, but they require facilitated transport
or carrier systems to move across the
____________ membrane into the interstitial
fluid, where they are absorbed into the
peritubular capillaries.
13. ___________ uses a carrier system in which
the downhill movement of one substance such
as sodium is coupled to the uphill movement
of another substance such as glucose or an
amino acid.
14. In the _____________ tubule, there is almost
complete reabsorption of nutritionally
important substances from the filtrate.
15. The plasma level at which the substance
appears in the urine is called the……………….
16. The _____________ establishes a high concen-
tration of osmotically active particles in the
interstitium surrounding the medullary collecting
tubules where the antidiuretic hormone (ADH)
exerts its effects.
17. The thick portion of the loop of Henle
contains a ______________ cotransport
system.
18. The _____________ tubule is relatively imper-
meable to water, and reabsorption of sodium
chloride from this segment further dilutes the
tubular fluid.
.
19. The _____________ assists in maintenance of
the extracellular fluid volume by controlling the
permeability of the medullary collecting
tubules.
20. Increased _____________ activity causes
constriction of the afferent and efferent arte-
rioles and thus a decrease in renal blood flow.
21. Renal _____________ is the volume of plasma
that is completely cleared each minute of any
substance that finds its way into the urine.
22. ________ functions in the regulation
ofsodium and potassium elimination.
23. Atrial natriuretic peptide contributes to the
regulation of……………………… elimination.
24. The kidneys regulate body pH by conserving
Base……………….. and eliminating
………………. ions.
25. ________ is an end product of protein
metabolism.
26. The synthesis of______________ is stimulated
by tissue hypoxia, which may be brought about
by anemia, residence at high altitudes, or
impaired oxygenation of tissues due to cardiac
or pulmonary disease.
27. …………………….represents excessive protein
excretion in the urine.
28. Urine _____________ provides a valuable
index of the hydration status and functional
ability of the kidneys.
29. ____________ levels in the blood and urine
can be used to measure glomerular filtration
rate (GFR).
30. …………………, therefore, is related to the GFR
but, unlike creatinine, also is influenced by
protein intake, gastrointestinal bleeding, and
hydration status.
 Briefly answer the following.
1. Describe the three layers of the glomerular
Match the key terms in Column A
membrane.
with their definitions in Column B.

Column A Column B
a Originate in the
1. Counter
transport superficial part of the 2. Describe the various methods of transport across
cortex the epithelial layer of the renal tubule.
.
2 Glomerular b Originate deeper in
filtration rate
the cortex
3. Vasopressin c Contribute to regu-
4. Cortical lation of glomerular
nephrons blood flow
d Milliliter of filtrate
5. Vitamin D formed per minute 3. How does the juxtaglomerular apparatus regu-
e The movement of one
late GFR?
6.Principal cells
substance enables the
7. Juxtamedullary
movement of a second
nephrons substance in the
8. Countercurrent opposite direction

9. Transport
f. Maximum amount of
maximum
substance that can be 4. What are the actions of atrial natriuretic pep-
10. Mesangial reabsorbed per unit tide (ANP)?
cells of time
9 Site of aldosterone
action
h Flow of fluids in
opposite directions
5. What are the endocrine functions of the kid-
i. Stimulate expression
ney?
of aquaporin-2
channels
j- Converted to active
form in kidney

6. How do Na+ blockers function as a diuretic?

Put the components of the renin-angiotensin-

aldosterone system in order from stimulation to
end hormone action:
• Conversion of angiotensin I to
angiotensin II by angiotensin converting
enzyme
• Decreased GFR
• Sodium and Water retention
• Angiotensin II stimulates release
of ADH and aldosterone
• Juxtaglomerular release of renin
Conversion of
angiotensinogen to
angiotensin I by renin

.
 Consider the scenario and answer 2. You are admitting to the floor a 45-year-old
the questions. woman with a presumptive diagnosis of diabetes
mellitus. While taking her history, she mentions
An 18-year-old girl is brought to the emergency that she has been eating a lot of sweets lately. How
department by her friends. Her blood pressure is would you expect this diet to impact her renal
115/85; pulse is 99; respiratory rate in 35 bpm. The system?
girl is doubled over and she is holding her abdomen
a. Decrease tubular reabsorption
saying, "I hurt so bad; I hurt so bad/' Her friends
deny the girl has been using recreational drugs. b. Increase renal blood flow
They tell the triage nurse that the girl started c. Decrease renal blood flow
complaining that her side hurt about 3 hours prior
d. Increase sodium excretion
to the trip to the emergency department. Asked if
the girl's parents had been notified, the friends tell
the triage nurse that they have been unable to reach 3. The renal clearance of a substance is measured
the girl's parents. On examination, a suspected independently. What are the factors that
diagnosis of kidney impairment is arrived at. determine renal clearance of a substance? (Mark
all that apply.)
1. What tests would the nurse expect to be ordered a. The ability of the substance to be filtered in
to either confirm or deny the diagnosis? the glomeruli
b. The capacity of the renal tubules to reabsorb
or secrete the substance
c. The normal electrolyte and pH composition
of the blood
d. The rate of renal blood flow
e. The rate sodium is excreted from the body

4. It is known that high levels of uric acid in the

blood can cause gout, while high levels in the
urine can cause kidney stones. What medication
2. The girl says, "My father just had a kidney stone competes with uric acid for secretion in to the
removed. Is that what I have?" What noninvasive tubular fluid, thereby reducing uric acid
test would the nurse expect to be ordered to rule secretion?
out a kidney stone? a. Ibuprofen
b. Acetaminophen
c. Aspirin
d. Advil

Answer the following questions.

5. Many drugs are eliminated in the urine.
1. Many substances are both filtered out of the
These drugs cannot be bound to plasma pro-
blood and reabsorbed into the blood in the
teins if the glomerulus is going to filter them
kidneys. What is the plasma level at which a
out of the blood. In what situation would it be
specific substance can be found in the urine?
necessary to create either an alkaline or acid
a. Renal threshold diuresis in a client?
b. Renal clearance a. Nontherapeutic drug levels in blood
c. Renal filtration rate b. Noncompliance with medication regimen
c. The need to use a loading dose of a specific
d. Renal transport level
drug and keep it in the system for a long time.
d. In the case of a drug overdose

.
 6. The anemia that occurs with end-stage kidney 9. An elderly man is brought into the clinic by
disease is often caused by the kidneys his daughter who states, "My father hasn't been
themselves. What inability of the kidney disease himself lately. Now I think he looks a little
causes anemia in end-stage kidney disease? yellow." What test would the nurse expect to have
a. Produce erythropoietin EPO ordered to check this man's creatinine level?
b. Produce rennin a. BUN level
c. Produce angiotensin b. 24 hour urine test
d. Inactivate vitamin D c. Urine test, first void in morning
7. Diuretics can either block the reabsorption of d. Serum creatinine
components of the urine, or they can block the 10. A patient suffering from a previous
reabsorption of water back into the body. What myocardial infarction is displaying an inabil-
does the increase in urine flow from the body ity to dilate the blood vessels and increased
depend on with a patient taking diuretics? sodium retention. Which hormone level may
a. The amount of water reabsorption back into have been affected by the MI?
the body
b. The amount of sodium and chloride reab-
sorption that it blocks a. ANP
c. The amount of sodium and chloride that it b ADH
.
excretes through the kidney c. BNP
d. The amount of water excreted by the body
d ACTH
8. Urine specific gravity is normally 1.010 to 1.025 .
with adequate hydration. When there is loss of
renal concentrating ability due to impaired renal
function, low concentration levels are exhibited.
When would the nurse consider the low levels of
concentration to be significant?
a. At noon
b. First void in morning
c. Last void at night
d. After a nap

.
Disorders of Renal Function
for Students
1. Describe the two types of immune
mechanisms involved in glomerular
disorders.
2. Use the terms proliferation, sclerosis, membranous,
diffuse, focal, segmental, and mesangial to explain
changes in glomerular structure that occur with
glomerulonephritis.
3. Relate the proteinuria, hematuria, pyuria,
oliguria, edema, hypertension, and azotemia
that occur with glomerulonephritis to changes
in glomerular structure.
4. Briefly describe the difference among the
nephritic syndromes, rapidly progressive
glomerulonephritis, nephrotic syndrome,
asymptomatic glomerular disorders, and
chronic glomerulonephritis.
5. Cite a definition of tubulointerstitial kidney
disease.
6. Differentiate between the defects in tubular
function that occur in proximal and distal
tubular acidosis.
7. Explain the pathogenesis of kidney damage in
acute and chronic pyelonephritis.
.
8 Describe the inheritance, pathology, and
manifestations of the different types of
polycystic kidney disease.
9. List four common causes of urinary tract
obstruction.
10. Define the term hydronephrosis and relate it to
the destructive effects of urinary tract
obstructions.
11. Describe the role of urine supersaturation,
nucleation, and inhibitors of stone formation in the
development of kidney stones.
12. Explain the mechanisms of pain and infection
that occur with kidney stones.
13. Describe methods used in the diagnosis and
treatment of kidney stones.
14. Cite the organisms most responsible for urinary
tract infections (UTIs) and state why urinary
catheters, obstruction, and reflux predispose to
infections.
15. List three physiologic mechanisms that
protect against UTIs.
16. Describe the signs and symptoms of UTIs.
17. Describe factors that predispose to UTIs in
children, sexually active women, pregnant
women, and older adults.
18. Compare the manifestations of UTIs in different
age groups, including infants, toddlers, adolescents,
adults, and older adults.
19. Cite measures used in the diagnosis and
treatment of UTIs.
20. Explain the vulnerability of the kidneys to
injury caused by drugs and toxins.
21. Characterize Wilms tumor in terms of age of
onset, possible oncogenic origin, manifestations, and
treatment.
22. Cite the risk factors for renal cell carcinoma,
describe its manifestations, and explain why the 5-
year survival rate has been so low.
Fill in the blanks.
1. Anomalies in _____________ and
of the kidneys are the most common form of
congenital renal disorder.
2. The term dysgenesis refers to a failure of an
organ to develop normally and ______________
refers to complete failure of an organ to
develop.
3. Newborns with renal agenesis often have
characteristic facial features, termed
____________ , resulting from the effects
of oligohydramnios.
4. In renal _____________ , the kidneys do not
develop to normal size.
5. Renal ____________ is due to an abnormality
in the differentiation of kidney structures
during embryonic development.
6. Unilateral _____________ renal dysplasia is the
most common cause of an abdominal mass in
newborns.
7. ………………. ……………….kidney diseases are a
group of
kidney disorders characterized by fluid-filled
sacs or segments that have their origin in the
tubular structures of kidney.
8. In the _____________ form of polycystic kidney
disease, thousands of large cysts are derived
from every segment of the nephron.
9. The _____________ effects of urinary obstruction
on kidney structures are determined by the degree
and the duration of the obstruction.
10. ____________ of urine predisposes to
infection, which may spread throughout
the urinary tract.
.
11. ………………. refers to urine-filled dilatation
of the renal pelvis and calyces associated with
progressive atrophy of the kidney due to
obstruction of urine outflow.
12. Obstruction of the urinary track may provoke
pain due to _____________ of the collecting
system and renal capsule.
13. The most common cause of upper urinary tract
obstruction is urinary _____________ __________
14. In addition to a supersaturated urine, kidney
stone formation requires a ______________ that
facilitates crystal aggregation.
15. Most kidney stones are ______________ stones.
16. The major manifestation of kidney stones
is………………………………………………...
17. Urinary tract infections are the _______________
most common type of bacterial infection seen
by health care providers.
18. Most uncomplicated lower UTIs are caused
by………………………
19. Most UTIs are caused by bacteria that enter
through the __________________
20. Urinary tract infections are ______________
common in women than men.
21. In UTIs associated with stasis of urine flow, the
obstruction may be ______________________ or…...
22. ……………… -associated bacteriuria remains
the most frequent cause of Gram-negative
septicemia in hospitalized patients.
23. An acute episode of ______________ is
characterized by frequency of urination, lower
abdominal or back discomfort, and burning
and pain on urination.
24. …………….. _ is second leading cause of kidney
failure worldwide and it ranks third, after diabetes
and hypertension, as a cause of chronic kidney
disease in the United States.
25. The _____________ syndromes produce a pro-
liferative inflammatory response, whereas the
……………… syndrome produces increased
permeability of the glomerulus.
26. …………….. syndrome is characterized by
sudden onset of hematuria, variable degrees of
proteinuria, diminished glomerular filtration
rate, oliguria, and signs impaired renal
function.
27. Acute postinfectious glomerulonephritis Consider the following figure.
usually occurs after infection with certain strains
of group A 0-hemolytic streptococci
and is caused by______________ of immune
complexes.
28. The ____________ of postinfectious glomeru-
lonephritis is caused by infiltration of leukocytes,
both neutrophils and monocytes; proliferation of
endothelial and mesangial cells; and, in severe
cases, formation of crescents.
29. ………………. syndrome is an uncommon
and aggressive form of glomerulonephritis that
is caused by antibodies to the glomerular
basement membrane.
30. ________ ………….……………….
……………..syndrome is characterized by
massive proteinuria and lipiduria, along with an
associated hypoalbuminemia, generalized edema,
and hyperlipidemia.
31. ___________ ……………glomerulonephritis is
caused by
diffuse thickening of the glomerular basement
membrane due to deposition of immune
complexes. In the figure above, identify the common locations
32. ___________ ………………is a primary and causes of urinary track obstructions:
Glomerulonephritis characterized by the
presence of glomerular IgA immune complex • Pregnancy or tumor
deposits. • Ureterovesical junction stricture
33. Alport syndrome represents a hereditary • Kidney stone
defect of the glomerular ______________ that
• Scar tissue
results in hematuria and may progress to chronic
renal failure. • Neurogenic bladder
34. ___________ …………………….refers to a group • Bladder outflow obstruction
of tubular
defects in reabsorption of bicarbonate ions Match the key terms in Column A
or excretion of hydrogen ions (H +) that result in with their definitions in Column B.
metabolic acidosis and its subsequent
complications, including metabolic bone disease, Column A Column B
kidney stones, and growth failure in children. a. Low renal mass in
1.Urease
35. Proximal renal tubular acidosis involves a 2.Hypogenesis infant
defect in proximal tubular reabsorption of……….. b Blood cells in
3. Oliguria .
urine
36. ________ ………..……………….represents an 4. PKD 1 and 2 c. Urea splitting bac
infection of the upper urinary tract, specifically terial enzyme
5. Hydronephrosis
the renal parenchyma and renal pelvis.
d. Change in renal
37. ________ ………………………….is one of the 6. Proteinuria structure
most common primary neoplasms of young
children. 7. Renal dysplasia e. Dilatation of the

8. Nephrolithiasis renal pelvis and

38. Kidney cancer is suspected when there are
calyces associated
findings of _____________________ and a
9. Hematuria with progressive
renal……………………………………………
10.Oligohydramn atrophy
io:

.
 f. Very low urine Briefly answer the following.
production
g. Genes responsible 1. What is the mechanism of tissue damage in
urinary track obstructions?
for autosomal
dominant polycystic
kidney disease
(ADPKD)
h. Kidney stone
formation
i. Protein loss in .
2 What are the factors involved in kidney stone
urine formation?
j, Low amniotic fluid
levels

3. For whom are the risk factors for UTIs higher?

4. What are the host defense mechanisms against

the development of a UTI?

5. What are the cellular changes associated with

glomerular disease?

6. Describe the disease progress and the production

of symptoms in poststreptococcal
glomerulonephritis.

Complete the above flowchart using the bullet points

below.
• Edema
• Hyperlipidemia
• Increased permeability to proteins 7. Describe the mechanisms of a diabetic
nephropathy.
• Decreased plasma oncotic pressure
• Hypoproteinemia
• Compensatory synthesis of proteins by liver
 8. How do medications and toxins from the 2. Match the type of polycystic kidney disorder
environment damage renal structures? with the characteristic cysts.
Type of Polycystic Kidney Disorder
1. Autosomal dominant polycystic kidney
disease (ADPKD)
2. Autosomal recessive polycystic kidney dis-
ease (ARPKD)
3. Acquired cysts
4. Nephronophthisis-medullary cystic kidney
disease
Characteristic Cysts
a. Small elongated cysts form in the collecting
Consider the scenario and answer
ducts and maintain contact with the nephron of
the question.
origin
An elderly woman, hospitalized with a b. The tubule wall, which is lined by a single
broken hip, has an indwelling catheter in layer of tubular cells, expands and then rapidly
place. On the third day of hospitalization closes the cyst off from the tubule of origin.
the woman's urine becomes cloudy and
foul smelling. The nurse knows that c. Cysts are restricted to the corticomedullary
catheters have a high incidence of causing border.
UTIs in hospitalized patients. d. Cysts that develop in the kidney as a
consequence of aging, dialysis, or other conditions
1. What orders would the nurse expect to
that affect tubular function
receive for this patient to determine if there
is an infection? 3. A young woman presents with signs and
symptoms of a UTI. The nurse notes that this is
the fifth UTI in as many months. What would
this information lead the nurse to believe?
a. There is possible obstruction in the urinary
tract
b. The woman has multiple sexual partners
c. The woman takes too many bubble baths
d. The woman does not clean herself as she
Answer the following questions. should
1. Congenital disorders of the kidneys are
4. Staghorn kidney stones, or struvite stones, are
fairly common, occurring in approximately
usually located in the renal pelvis. These stones
1:1000 live births. What is the result to the
are made from what?
newborn when bilateral renal dysplasia occurs?
(Mark all that apply.) a. Calcium oxalate
a. Potter facies b. Magnesium ammonium phosphate
b. Oligohydramnios c. Cystine
c. Pulmonary hypoplasia d. Uric acid
d. Multicystic kidneys 5. What is the most common cause of a lower
e. Renal failure UTI?
a. Staphylococcus saprophyticus
b. Pseudomonas aeruginosa
c. Escherichia coli E.coli
d. Staphylococcus aureus
9. Urinary tract infections in children do not
generally present as UTIs as they do in adults. 6. Acute pyelonephritis is an infection of the
What are the signs and symptoms of a UTI in a renal parenchyma and renal pelvis. What is the
toddler? (Mark all that apply.) most common cause of acute pyelonephritis?
a. Frequency a. Group A 0-hemolytic streptococci
b. Diarrhea b. P. aeruginosa
c. Abdominal pain c. Haemophilus influenza
d. Poor growth d. Candida albicans
e. Burning 7. Drug-related nephropathies occur all too
10. Acute postinfectious glomerulonephritis, as often. They involve functional and/or structural
its name implies, follows an acute infection changes to the kidney after exposure to a drug.
somewhere else in the body. What is the most What does the tolerance to drugs depend on?
common cause of acute postinfectious a. Vesicoureteral reflux
glomerulonephritis ? b. Glomerular filtration rate
a. E. coli c. State of hydration
b. S. aureus d. Proteinuria
c. P. aeruginosa 8. Wilms tumor is a tumor of childhood. It is
d. Group A (3-hemolytic streptococci usually an encapsulated mass occurring in any
part of the kidney. What are the common
11. Both type I and type II diabetes mellitus can
presenting signs of a Wilms tumor?
cause damage to the glomeruli of the kidneys.
What renal disease is diabetic nephropathy a. Hypotension and a large abdominal mass
associated with? b. Vomiting and oliguria
a. Nephrotic syndrome c. Abdominal pain and diarrhea
b. Acute glomerulonephritis d. Large asymptomatic abdominal mass and
hypertension
c. Nephritic syndrome
d. Acute glomerulonephritis